Temporal association between drops in thoracic impedance and malignant ventricular arrhythmia: A longitudinal analysis of remote monitoring trends

• Published in: Journal of cardiovascular electrophysiology 2023-04, Vol.34 (4), p.947-956
• Main Authors: Rodio, Giovanna, Iacopino, Saverio, Pisanò, Ennio C., Calvi, Valeria, Rovaris, Giovanni, Marini, Massimiliano, Giammaria, Massimo, Caravati, Fabrizio, Maglia, Giampiero, Zanotto, Gabriele, Della Bella, Paolo, Biffi, Mauro, Curnis, Antonio, Maines, Massimiliano, Orsida, Daniela, Santamaria, Matteo, Bisignani, Giovanni, Baroni, Matteo, Lissoni, Fabio, Duca, Antonio, Forleo, Giovanni B., Piemontese, Carlo, De Salvia, Alberto, Miracapillo, Gennaro, Celentano, Eduardo, Zecchin, Massimo, Luzzi, Giovanni, Giacopelli, Daniele, Gargaro, Alessio, D'Onofrio, Antonio
• Format: Article
• Language: English
• Subjects: Arrhythmia; Arrhythmias, Cardiac - therapy; Cardiac arrhythmia; cardiac resynchronization therapy; Defibrillators; Electric Impedance; heart failure; Humans; implantable cardioverter defibrillator; Retrospective Studies; Tachycardia; Tachycardia, Ventricular; thoracic impedance; Thorax; Trends; Ventricle; ventricular arrhythmias; Ventricular Fibrillation
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.15834

Introduction Thoracic impedance (TI) drops measured by implantable cardioverter‐defibrillators (ICDs) have been reported to correlate with ventricular tachycardia/fibrillation (VT/VF). The aim of our study was to assess the temporal association of decreasing TI trends with VT/VF episodes through a longitudinal analysis of daily remote monitoring data from ICDs and cardiac resynchronization therapy defibrillators (CRT‐Ds). Methods and Results Retrospective data from 2384 patients were randomized 1:1 into a derivation or validation cohort. The TI decrease rate was defined as the percentage of rolling weeks with a continuously decreasing TI trend. The derivation cohort was used to determine a TI decrease rate threshold for a ≥99% specificity of arrhythmia prediction. The associated risk of VT/VF episodes was estimated in the validation cohort by dividing the available follow‐up into 60‐day assessment intervals. Analyses were performed separately for 1354 ICD and 1030 CRT‐D patients. During a median follow‐up of 2.0 years, 727 patients (30.4%) experienced 3298 confirmed VT/VF episodes. In the ICD group, a TI decrease rate of >60% was associated with a higher risk of VT/VF episode in a 60‐day assessment interval (stratified hazard ratio, 1.42; 95% confidence interval (CI), 1.05–1.92; p = .023). The TI decrease preceded (40.8%) or followed (59.2%) the VT/VF episodes. In the CRT‐D group, no association between TI decrease and VT/VF episodes was observed (p = .84). Conclusion In our longitudinal analysis, TI decrease was associated with VT/VF episodes only in ICD patients. Preventive interventions may be difficult since episodes can occur before or after TI decrease.